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UPDATED: Lameness gurus and enthusiasts: The lameness-less but injured fetlock

Vet discussed possible combination of additional joint injections, IRAP, and use of daily Equimax - all in attempt to keep horse sound for a lesson once a week. Vet does not anticipate horse could be shown, as the drugs would test (obviously) and horse would unlikely be sound without daily pharmaceuticals. Regular riding would need to be strictly limited.

Because of the significant degeneration that has occurred over the past 11 months - plus the poor bone quality, new bone spurs, chips, avulsions, etc etc I have decided to put him down. This horse is not happy when not ridden regularly and would not be safe nor sound for just trail rides other than on idyllic footing.

Thank you to all who took the time to share their thoughts, opinions, and advice.

--------------------Original Post----------------------
Horse presents with negative behaviors only to the right only at the canter. Horse’s training history and general work attitude do not point towards sourness/training issue. Scintigraphy, examination, and x-rays show the following:
-Right front fetlock: moderate to marked update over joint and sesamoid area.
-Jogs evenly on hand on firm surface – in other words, horse never presents ‘lame’
-Synovial cyst on lateral aspect of fetlock (thought to be unrelated to lameness and not harmful)
-Positive flexion of right front limb

Examination Conclusions: Degenerative changes in joint. Smooth round chip off proximal rim of P1. Another chip off palmar aspect of P1 with bony changes in sesamoid bones. Surgery to remove chips is not recommended due to degeneration within joint.

Horse’s fetlock is injected first time. Returns to work and does so well that vet recommends return to jumping. Comes up with negative behaviors again after jumping is reintroduced. Injected again. Behaviors are non-existent but horse is not being worked consistently. Horse is sold to different owner with expectations to be used for flatwork only.

Horse starts negative behaviors again- only at canter to the right. Still sound. Fetlock is injected. Joint flare episode renders horse slightly off for four days following injection. Horse starts back into work a week later. New symptoms and attitude points towards ulcers. Horse is treated for ulcers, new symptoms disappear. Three days back into consistent work (4 weeks post injection) horse displays negative behaviors at right lead canter, again.

Suggestions?
-Inject joint again?
-X-ray again to see if chips have changed location? Last x-rays taken 11 months ago.
-Try something like Adequan?
-Something else….

The big difficulty here is that the horse does not come up lame. Which, I believe, makes it difficult or rather impossible/pointless to block. I’m not sure I’d want to ride a blocked horse either – especially since pain is demonstrated through progressively acrobatic negative behavior.

I am at a loss as to what the 'next step' is and would welcome any and all suggestions.

If the right front limb still flexes positive then you know your injections to date have worn off or are just not working so time to try something more aggressive. If there is a positive flexion and negative behavior I would be calling the horse lame - get the vet to test the flexion and re-xay. I might try a course of IV Legend and IM Adequan before moving to IRAP etc. Shock wave might help too. Best course of action is to find the best lameness vet you can find and consult with them - they will be experienced in working with tougher cases. You could also consider turning to a simple bute protocol to see if it controls the pain\behavior (have to be careful about the ulcers though). Good luck!

He will buck (small ones growing to larger) swish his tail, swing his head, grind his teeth, or bundle himself up and crowhop.

I do not *think* saddle fit is the issue. The behaviors have occurred with two different riders and with three different saddles. I am rather fanatical about saddle fit, thanks to previous horses.

Horse has been under my care for five weeks. He has been lunged very sporadically in his past years - and it was used as a 'get all the bucks out you can' tool. So it is very difficult to evaluate him on the lunge line, as he bucks/launches himself in either direction immediately regardless of 'instructions.' One of my priorities is to teach/re-teach this horse to lunge.

Horse is very inactive in the pasture because of erm, he enjoys grass a lot. His companions are arthritic and ancient - not very conducive to 'wooohoo! moments" I have seen him canter twice. Once on left lead, once on right. Undersaddle on his pain-free days, he has no issues picking up or cantering to the right. In fact, I might argue it is his stronger lead! The few strides between bucks feel normal - it is not unbalance or sticky.

"bony changes in sesamoid" is an understatement .
The "bony changes" are severe, IMO. The sesamoid is trashed.
I would never, ever consider jumping a horse with this much damage to a sesamoid at the suspensory ligament connection.
I would shoe with some kind of full roller motion shoe that allows eased movement in any direction, and forget about any kind of jumping or performance work.

Hi Patty -
Thanks for your reply. My original post was unclear - the jumping was with the previous owner. I have no interest in jumping. I am hoping for 2nd level dressage (maybe 3rd level dressage down the road) and trail rides.

This is a big favor - but could you please explain to me what/where you see in the sesamoids in the xrays? I can see the chips but do not have an educated enough eye to put much judgement on the sesamoids. Not questioning you at all - just trying to learn.

This is a big favor - but could you please explain to me what/where you see in the sesamoids in the xrays?

Here. I do not know many veterinrians who would not deem these as significant or severe seamoid injuries. A couple look like avulsion fractures, (the pulling of a section of bone off where a ligament attaches).